Basic Surgery (100q).1

100 Questions | Total Attempts: 2368

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Basic Surgery (100q).1

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Questions and Answers
  • 1. 
    • A. 

      Lean body mass increases.

    • B. 

      Total body water increases.

    • C. 

      Adipose tissue decreases.

    • D. 

      Body weight decreases.

  • 2. 
    The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
    • A. 

      Hypermetabolism.

    • B. 

      Fever

    • C. 

      Tachypnea

    • D. 

      Hyperphagia

    • E. 

      Negative nitrogen balance.

  • 3. 
     Shock can best be defined as:
    • A. 

      Hypotension

    • B. 

      Hypoperfusion of tissues.

    • C. 

      Hypoxemia

    • D. 

      All of the above.

  • 4. 
    • A. 

      Cytokines act directly on target cells and may potentiate the actions of one another.

    • B. 

      Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.

    • C. 

      Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.

    • D. 

      Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates

  • 5. 
    All of the following are true about neurogenic shock except:
    • A. 

      There is a decrease in systemic vascular resistance and an increase in venous capacitance.

    • B. 

      Tachycardia or bradycardia may be observed, along with hypotension.

    • C. 

      The use of an alpha agonist such as phenylephrine is the mainstay of treatment

    • D. 

      Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

  • 6. 
    • A. 

      Dobutamine

    • B. 

      Sodium nitroprusside.

    • C. 

      Pneumatic antishock garment.

    • D. 

      Intra-aortic balloon pump

  • 7. 
    • A. 

      There are no primary alterations in cardiovascular signs

    • B. 

      Signs of increased intracranial pressure may be masked by the hyponatremia.

    • C. 

      Oliguric renal failure is an unlikely complication

    • D. 

      Rapid correction of the hyponatremia may prevent central pontine injury

    • E. 

      This patient is best treated by restriction of water intake.

  • 8. 
    • A. 

      The total extracellular fluid volume represents 40% of the body weight.

    • B. 

      The plasma volume constitutes one fourth of the total extracellular fluid volume

    • C. 

      Potassium is the principal cation in extracellular fluid.

    • D. 

      The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid

    • E. 

      The interstitial fluid equilibrates slowly with the other body compartments.

  • 9. 
    1.       Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
    • A. 

      The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.

    • B. 

      With normal renal function, this patient is likely to be volume overloaded.

    • C. 

      Proper fluid therapy would be unlikely to include potassium administration

    • D. 

      Insulin administration will increase the potassium content of cells.

    • E. 

      Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

  • 10. 
    Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
    • A. 

      Age over 70 years.

    • B. 

      Chronic malnutrition.

    • C. 

      Controlled diabetes mellitus.

    • D. 

      Long-term steroid use.

    • E. 

      Infection at a remote body site.

  • 11. 
    • A. 

      Myocardial infarct 4 months previously.

    • B. 

      Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl. hemoglobin.

    • C. 

      Premature atrial or ventricular contractions on electrocardiogram

    • D. 

      A harsh aortic systolic murmur.

    • E. 

      Age over 70 years.

  • 12. 
    • A. 

      Whole blood is the most commonly used red cell preparation for transfusion in the United States.

    • B. 

      Whole blood is effective in the replacement of acute blood loss.

    • C. 

      Most blood banks in the United States have large supplies of whole blood available.

    • D. 

      The use of whole blood produces higher rates of disease transmission than the use of individual component therapies

  • 13. 
    • A. 

      Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.

    • B. 

      Two units of FFP should be given with every 5 units of packed red blood cells in most cases

    • C. 

      A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases.

    • D. 

      One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis.

    • E. 

      One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

  • 14. 
     The evaluation of a patient scheduled for elective surgery should always include the following as tests of hemostasis and coagulation:
    • A. 

      History and physical examination.

    • B. 

      Complete blood count (CBC), including platelet count

    • C. 

      Prothrombin time (PT) and activated partial thromboplastin time (APTT).

    • D. 

      Studies of platelet aggregation with adenosine diphosphate (ADP) and epinephrine

  • 15. 
    • A. 

      An allergic reaction.

    • B. 

      An anaphylactoid reaction.

    • C. 

      A clerical error.

    • D. 

      An acute bacterial infection transmitted in blood.

  • 16. 
    • A. 

      This formulation is proposed for the use of patients with fulminant hepatitis

    • B. 

      Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours.

    • C. 

      The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy

    • D. 

      In some studies of surgical patients, improvements in mortality have been reported.

  • 17. 
    • A. 

      Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow

    • B. 

      In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied.

    • C. 

      Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition

    • D. 

      Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

  • 18. 
    • A. 

      In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated

    • B. 

      In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose.

    • C. 

      In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding.

    • D. 

      CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support

  • 19. 
    • A. 

      Gallstones occur with the same frequency in diabetes patients as in the healthy population.

    • B. 

      The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient.

    • C. 

      Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk.

    • D. 

      The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.

    • E. 

      Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

  • 20. 
    • A. 

      Prevents the aggressive development of atherosclerosis in diabetic patients

    • B. 

      Is not associated with unawareness of hypoglycemia.

    • C. 

      Improves peripheral neuropathy

    • D. 

      Improves established retinopathy and nephropathy

    • E. 

      Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).

  • 21. 
    What is the major determinant in an individual patient's risk for perioperative complications?
    • A. 

      The surgical procedure.

    • B. 

      The length of the surgical procedure.

    • C. 

      The anesthetic technique (e.g., general, regional).

    • D. 

      The length of anesthesia.

    • E. 

      All of the above.

  • 22. 
    Advantages of epidural analgesia include:
    • A. 

      Earlier mobilization after surgery.

    • B. 

      Earlier return of bowel function.

    • C. 

      Shorter hospitalizations.

    • D. 

      Decreased stress response to surgery.

    • E. 

      All of the above

  • 23. 
    • A. 

      Protein depletion.

    • B. 

      Infection

    • C. 

      Anemia

    • D. 

      Advanced age.

    • E. 

      Hypoxia

  • 24. 
    • A. 

      Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes

    • B. 

      Lymphocytes are the primary blood cell involved with this process

    • C. 

      The process involves a coating of the cytoplasmic surface known as clathrin

    • D. 

      Phagocytosis is performed only by white blood cells and tissue macrophages

  • 25. 
    • A. 

      The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration

    • B. 

      The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium

    • C. 

      The selectivity of biologic membranes is highly consistent and seldom changes

    • D. 

      The selectivity of cell membranes relates only to ions and not organic compounds

  • 26. 
    • A. 

      DNA is contained only in the nucleus of the cell

    • B. 

      DNA strands are encoded by the sequence of four bases—adenine, guanine, cytosine and uridine

    • C. 

      The basic unit of information of DNA is the intron, a sequence of three bases

    • D. 

      There are an infinite number of possible codons

  • 27. 
    • A. 

      The first step in gene transcription involves separating the double helix of DNA by an enzyme known as DNA polymerase

    • B. 

      The initial product of DNA transcription is called heterogeneous nuclear RNA which codes directly for proteins

    • C. 

      After processing is complete, the mRNA is exported from the nucleus to the cytoplasm

    • D. 

      Only one protein can be produced from an initial mRNA strand

  • 28. 
    • A. 

      The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 25% of preinjury weight

    • B. 

      Under-nutrition may compromise the patient’s available defense mechanisms

    • C. 

      Nutritional support is an immediate priority for the trauma patient

    • D. 

      Fifty percent of non-nitrogen caloric requirements should be provided in the form of fat

  • 29. 
    • A. 

      Preoperative nutritional support should be provided to all patients with cancer

    • B. 

      To be effective, preoperative nutrition must be given for at least two weeks preoperatively

    • C. 

      Parenteral nutrition is the preferred route of feeding for all cancer patients

    • D. 

      Standard total parenteral nutrition solutions maintain integrity of the small bowel

    • E. 

      None of the above

  • 30. 
    • A. 

      Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis

    • B. 

      A major disadvantage of the peripheral technique is limited caloric delivery

    • C. 

      If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site

    • D. 

      Venous thrombosis is an uncommon complication for long-term central vein catheterization

  • 31. 
    • A. 

      Glutamine is an essential amino acid

    • B. 

      Glutamine appears to be of primary benefit in critical illness

    • C. 

      Glutamine is included in most standard TPN solutions

    • D. 

      Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

  • 32. 
    • A. 

      Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition

    • B. 

      Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens

    • C. 

      Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements

    • D. 

      A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding

  • 33. 
    • A. 

      A wet-to-dry dressing is the most optimal form of wound management

    • B. 

      A moist occlusive dressing promotes epithelialization and reduces pain

    • C. 

      The protein rich plasma exudate covering the open wound facilitates healing

    • D. 

      Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process

  • 34. 
    • A. 

      Frequent surgical debridement is usually necessary

    • B. 

      Water irrigation can effectively debride most wounds

    • C. 

      Hydrogen peroxide is particularly useful in the management of open wounds

    • D. 

      A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing

  • 35. 
    • A. 

      Systemic antibiotics are indicated for all open wounds

    • B. 

      Bacterial resistance can occur with systemic but not topical antibiotics

    • C. 

      An indication for systemic antibiotic administration is a granulation tissue bacterial count in excess of greater than 105 organisms/gram of tissue on quantitative analysis

    • D. 

      Silver sulfadiazine is useful only for the management of burns

  • 36. 
    Scar formation is part of the normal healing process following injury. Which of the following tissues has the ability to heal without scar formation?
    • A. 

      Liver

    • B. 

      Skin

    • C. 

      Bone

    • D. 

      Muscle

  • 37. 
    • A. 

      Vitamin A supplementation

    • B. 

      Vitamin C supplementation

    • C. 

      Vitamin E application to the wound

    • D. 

      Zinc supplementation

    • E. 

      None of the above

  • 38. 
    • A. 

      Keloids occur randomly regardless of gender or race

    • B. 

      Hypertrophic scars and keloid are histologically different

    • C. 

      Keloids tend to develop early and hypertrophic scars late after the surgical injury

    • D. 

      Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention

  • 39. 
    • A. 

      Vasoconstriction is an early event in the response to injury

    • B. 

      Vasodilatation is a detrimental response to injury with normal body processes working to avoid this process

    • C. 

      Vascular permeability is maintained to prevent further cellular injury

    • D. 

      Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important mediators of local vasoconstriction

  • 40. 
    • A. 

      Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications

    • B. 

      A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding

    • C. 

      Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy

    • D. 

      A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal

  • 41. 
    • A. 

      While IL-1 and TNFa share many biologic effects, IL-1 appears to be more potent

    • B. 

      IL-1 expression is in part autoregulated

    • C. 

      IL-1 inhibits prostaglandin production

    • D. 

      The ability of IL-1 to upregulate endothelial cell-neutrophil adhesion molecules is relatively limited

  • 42. 
    • A. 

      All antibodies are composed of one type of heavy and one type of light protein chain

    • B. 

      The carboxyl terminus of the heavy chain is the antigen binding site

    • C. 

      Antibody of the immunoglobulin G class is the initial antibody produced in response to an antigenic stimulus

    • D. 

      Immunoglobulins A, D, and E play an active role in the circulating humoral response

  • 43. 
    • A. 

      The issue of toxic side effects of antibiotics is only important in dealing with emperic therapy

    • B. 

      Single agent therapy is generally inferior to specific multi-drug therapy (aminoglycoside plus an antianaerobic agent) for the treatment of secondary bacterial peritonitis due to appendicitis, diverticulitis, penetrating gastrointestinal injury, or anastomotic leak

    • C. 

      With the empiric use of antibiotics, a diligent search for the septic source should be undertaken and continued until identified

    • D. 

      In clinical situations in which polymicrobial infection is identified, specifically-directed treatment for the predominant organism is satisfactory

  • 44. 
    • A. 

      Cytokines are produced solely by macrophages

    • B. 

      Cytokines act only on other cells within the same local environment

    • C. 

      Cytokines may have both protective and deleterious effects on the host

    • D. 

      Each specific cytokine is produced by a single cell type

  • 45. 
    • A. 

      The appropriate use of prophylactic antibiotics must include the initiation of the agent prior to the surgical procedure

    • B. 

      Continuing the antibiotic into the postoperative period has led to improved results in antibiotic prophylaxis

    • C. 

      The prophylactic administration of broad-spectrum agents (third-generation cephalosporins) has been shown to be particularly advantageous

    • D. 

      The topical use of antimicrobial agents is of no advantage in the prophylactic setting

  • 46. 
    • A. 

      Gut decontamination

    • B. 

      Anti-LPS antibody

    • C. 

      Anti-TNF antibody

    • D. 

      Thymopentin

    • E. 

      None of the above

  • 47. 
    • A. 

      A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock

    • B. 

      The treatment of shock is generic regardless of the etiology

    • C. 

      Pharmacologic intervention to increase myocardial contractility in hypovolemic shock is an important part the early management

    • D. 

      Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

  • 48. 
    • A. 

      The patient likely is suffering from hypovolemic shock and should respond quickly to fluid resuscitation

    • B. 

      Beck’s triad will likely be an obvious indication of compressive cardiogenic shock due to pericardial tamponade

    • C. 

      Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade

    • D. 

      The placement of bilateral chest tubes will likely resolve the problem

  • 49. 
    • A. 

      The low blood pressure can be assumed to be due to neurogenic shock

    • B. 

      The sole cause of hypotension is the loss of sympathetic input to the venous system

    • C. 

      Despite significant hypotension, secondary organ injury will be uncommon

    • D. 

      There is no role for pharmacologic intervention to maintain blood pressure

  • 50. 
    • A. 

      The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents

    • B. 

      The circulatory derangements of septic shock precede the development of metabolic abnormalities

    • C. 

      Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance

    • D. 

      Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

  • 51. 
    Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock?
    • A. 

      The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway of the compliment cascade

    • B. 

      Eicosanoids, such as prostaglandins are stored in platelets and endothelial cells and released in response to inflammatory stimuli

    • C. 

      Thromboxane and PGI2 have similar effects

    • D. 

      Platelet-activating factor can be released by both circulating and fixed tissue cells

  • 52. 
    Which of the following statement(s) is/are correct concerning the cardiovascular response to shock?
    • A. 

      Changes in cardiac contractile function shift the Frank Starling curve up and down

    • B. 

      Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock

    • C. 

      Arterial vasoconstriction affects all vascular beds equally

    • D. 

      The total circulating blood volume is equally split between the arterial and venous system

  • 53. 
    • A. 

      A change in oxygen consumption is followed by a proportionate change in oxygen delivery

    • B. 

      A change in oxygen delivery is followed by a change in oxygen consumption

    • C. 

      Increases in oxygen delivery are due solely to an increase in cardiac output

    • D. 

      The normal ratio of oxygen delivery to consumption is 2:1

  • 54. 
    Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema?  
    • A. 

      Diuresis and blood transfusion is a valuable step

    • B. 

      Salt-poor albumin leaks through the capillaries and worsens the condition

    • C. 

      Mannitol is contraindicated as a diuretic in this clinical situation

    • D. 

      Isoproterenol is a poor choice as an ionotropic agent

  • 55. 
    • A. 

      Conventional serum proteins such as albumin and globulin are early indicators of malnutrition

    • B. 

      The total lymphocyte count reflects immune status and not nutrition

    • C. 

      Antigen skin testing reflects patient immunity and not nutrition

    • D. 

      Measurement of urea excretion in urine can be used as a measurement of protein breakdown

  • 56. 
    • A. 

      Generalized increased capillary permeability

    • B. 

      A hypermetabolic state

    • C. 

      Organ malfunction

    • D. 

      All of the above

  • 57. 
    • A. 

      Pulmonary edema effectively narrows bronchi and increases pulmonary vascular resistance

    • B. 

      Ventilation and perfusion are decreased equally

    • C. 

      Positive pressure ventilation improves gas exchange by decreasing lung edema

    • D. 

      The condition is frequently caused by decreased plasma protein levels

  • 58. 
    • A. 

      Both the extracellular and intracellular components of total body water can be directly measured

    • B. 

      The intravascular space accounts for the majority of extracellular fluid

    • C. 

      All water in the interstitial space is freely exchangeable

    • D. 

      Transcellular fluid, separated from other compartments by both endothelial and epithelial barriers, constitute about 4% of total body water

  • 59. 
    • A. 

      Maximal renal compensation for metabolic acidosis occurs before full respiratory compensation can occur

    • B. 

      All patients with lactic acidosis should receive prompt treatment with bicarbonate

    • C. 

      Potassium replacement is essential even in the face of normal or high serum potassium when treating diabetic ketoacidosis

    • D. 

      Sodium bicarbonate administration should begin simultaneous with volume resuscitation in patients with hypoxia secondary to shock

  • 60. 
    • A. 

      Narcotics have both profound analgesic and amnestic properties

    • B. 

      Narcotics can cause hypotension by direct myocardial depressive effects

    • C. 

      Naloxone should be used routinely for the reversal of narcotic analgesia

    • D. 

      Acutely injured hypovolemic patients are at significant risk for decreased blood pressure with the use of narcotic analgesics

    • E. 

      Propofol is a new intravenous short-acting narcotic used frequently in the outpatient setting

  • 61. 
    In “catabolic” surgical patients, which of the following changes in body composition do not occur?
    • A. 

      Lean body mass increases.

    • B. 

      Total body water increases.

    • C. 

      Adipose tissue decreases.

    • D. 

      Body weight decreases.

  • 62. 
    Narcotics are commonly used in the administration of general anesthesia. Which of the following statement(s) is/are true concerning this class of agents.
    • A. 

      Narcotics have both profound analgesic and amnestic properties

    • B. 

      Narcotics can cause hypotension by direct myocardial depressive effects

    • C. 

      Naloxone should be used routinely for the reversal of narcotic analgesia

    • D. 

      Acutely injured hypovolemic patients are at significant risk for decreased blood pressure with the use of narcotic analgesics

    • E. 

      Propofol is a new intravenous short-acting narcotic used frequently in the outpatient setting

  • 63. 
    Which of the following statement(s) is/are true concerning the compensatory mechanisms and treatment of metabolic acidosis?
    • A. 

      Maximal renal compensation for metabolic acidosis occurs before full respiratory compensation can occur

    • B. 

      All patients with lactic acidosis should receive prompt treatment with bicarbonate

    • C. 

      Potassium replacement is essential even in the face of normal or high serum potassium when treating diabetic ketoacidosis

    • D. 

      Sodium bicarbonate administration should begin simultaneous with volume resuscitation in patients with hypoxia secondary to shock

  • 64. 
     Which of the following statement(s) is/are correct concerning the body fluid compartments?
    • A. 

      Both the extracellular and intracellular components of total body water can be directly measured

    • B. 

      The intravascular space accounts for the majority of extracellular fluid

    • C. 

      All water in the interstitial space is freely exchangeable

    • D. 

      Transcellular fluid, separated from other compartments by both endothelial and epithelial barriers, constitute about 4% of total body water

  • 65. 
     Which of the following statement(s) is/are true concerning pulmonary edema?  
    • A. 

      Pulmonary edema effectively narrows bronchi and increases pulmonary vascular resistance

    • B. 

      Ventilation and perfusion are decreased equally

    • C. 

      Positive pressure ventilation improves gas exchange by decreasing lung edema

    • D. 

      The condition is frequently caused by decreased plasma protein levels

  • 66. 
    Intensive insulin therapy:
    • A. 

      Prevents the aggressive development of atherosclerosis in diabetic patients

    • B. 

      Is not associated with unawareness of hypoglycemia.

    • C. 

      Improves peripheral neuropathy

    • D. 

      Improves established retinopathy and nephropathy

    • E. 

      Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).

  • 67. 
    An important step in protein synthesis is transcription. Which of the following statement(s) is/are true concerning this process?
    • A. 

      The first step in gene transcription involves separating the double helix of DNA by an enzyme known as DNA polymerase

    • B. 

      The initial product of DNA transcription is called heterogeneous nuclear RNA which codes directly for proteins

    • C. 

      After processing is complete, the mRNA is exported from the nucleus to the cytoplasm

    • D. 

      Only one protein can be produced from an initial mRNA strand

  • 68. 
    Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition?
    • A. 

      Glutamine is an essential amino acid

    • B. 

      Glutamine appears to be of primary benefit in critical illness

    • C. 

      Glutamine is included in most standard TPN solutions

    • D. 

      Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

  • 69. 
    Advantages of epidural analgesia include:
    • A. 

      Earlier mobilization after surgery.

    • B. 

      Earlier return of bowel function.

    • C. 

      Shorter hospitalizations.

    • D. 

      Decreased stress response to surgery.

    • E. 

      All of the above

  • 70. 
    Which of the following statement(s) is/are true concerning the cell function of phagocytosis?
    • A. 

      Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes

    • B. 

      Lymphocytes are the primary blood cell involved with this process

    • C. 

      The process involves a coating of the cytoplasmic surface known as clathrin

    • D. 

      Phagocytosis is performed only by white blood cells and tissue macrophages

  • 71. 
    Which of the following statement(s) is/are true concerning the indications and administration of nutritional support to cancer patients?
    • A. 

      Preoperative nutritional support should be provided to all patients with cancer

    • B. 

      To be effective, preoperative nutrition must be given for at least two weeks preoperatively

    • C. 

      Parenteral nutrition is the preferred route of feeding for all cancer patients

    • D. 

      Standard total parenteral nutrition solutions maintain integrity of the small bowel

    • E. 

      None of the above

  • 72. 
     Which of the following factors have been demonstrated to promote wound healing in normal individuals?
    • A. 

      Vitamin A supplementation

    • B. 

      Vitamin C supplementation

    • C. 

      Vitamin E application to the wound

    • D. 

      Zinc supplementation

    • E. 

      None of the above

  • 73. 
    • A. 

      Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes

    • B. 

      Lymphocytes are the primary blood cell involved with this process

    • C. 

      The process involves a coating of the cytoplasmic surface known as clathrin

    • D. 

      Phagocytosis is performed only by white blood cells and tissue macrophages

  • 74. 
    The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
    • A. 

      Hypermetabolism.

    • B. 

      Fever

    • C. 

      Tachypnea

    • D. 

      Hyperphagia

    • E. 

      Negative nitrogen balance.

  • 75. 
    Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true?
    • A. 

      Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications

    • B. 

      A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding

    • C. 

      Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy

    • D. 

      A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal

  • 76. 
     In patients receiving massive blood transfusion for acute blood loss, which of the following is/are correct?
    • A. 

      Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.

    • B. 

      Two units of FFP should be given with every 5 units of packed red blood cells in most cases

    • C. 

      A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases.

    • D. 

      One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis.

    • E. 

      One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

  • 77. 
     A striking feature of living cells is a marked difference between the composition of the cytosol and the extracellular milieu. Which of the following statement(s) concerning the mechanisms of maintenance of these differences is/are true?
    • A. 

      The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration

    • B. 

      The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium

    • C. 

      The selectivity of biologic membranes is highly consistent and seldom changes

    • D. 

      The selectivity of cell membranes relates only to ions and not organic compounds

  • 78. 
    Which of the following statement(s) is/are true concerning nutritional support of the injured patient?
    • A. 

      The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 25% of preinjury weight

    • B. 

      Under-nutrition may compromise the patient’s available defense mechanisms

    • C. 

      Nutritional support is an immediate priority for the trauma patient

    • D. 

      Fifty percent of non-nitrogen caloric requirements should be provided in the form of fat

  • 79. 
    Which of the following statements about the presence of gallstones in diabetes patients is/are correct?
    • A. 

      Gallstones occur with the same frequency in diabetes patients as in the healthy population.

    • B. 

      The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient.

    • C. 

      Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk.

    • D. 

      The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.

    • E. 

      Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

  • 80. 
    1.       Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
    • A. 

      The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.

    • B. 

      With normal renal function, this patient is likely to be volume overloaded.

    • C. 

      Proper fluid therapy would be unlikely to include potassium administration

    • D. 

      Insulin administration will increase the potassium content of cells.

    • E. 

      Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

  • 81. 
    A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following statements is/are true?
    • A. 

      This formulation is proposed for the use of patients with fulminant hepatitis

    • B. 

      Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours.

    • C. 

      The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy

    • D. 

      In some studies of surgical patients, improvements in mortality have been reported.

  • 82. 
    Glucose overload results in increased CO 2 production. Which of the following statements are true?
    • A. 

      In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated

    • B. 

      In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose.

    • C. 

      In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding.

    • D. 

      CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support

  • 83. 
     Which of the following statement(s) concerning intravenous nutritional support is/are true?
    • A. 

      Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis

    • B. 

      A major disadvantage of the peripheral technique is limited caloric delivery

    • C. 

      If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site

    • D. 

      Venous thrombosis is an uncommon complication for long-term central vein catheterization

  • 84. 
    Which of the following statement(s) is/are true concerning septic shock?
    • A. 

      The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents

    • B. 

      The circulatory derangements of septic shock precede the development of metabolic abnormalities

    • C. 

      Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance

    • D. 

      Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

  • 85. 
    Which of the following statement(s) is/are correct concerning the cardiovascular response to shock?
    • A. 

      Changes in cardiac contractile function shift the Frank Starling curve up and down

    • B. 

      Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock

    • C. 

      Arterial vasoconstriction affects all vascular beds equally

    • D. 

      The total circulating blood volume is equally split between the arterial and venous system

  • 86. 
    Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema?  
    • A. 

      Diuresis and blood transfusion is a valuable step

    • B. 

      Salt-poor albumin leaks through the capillaries and worsens the condition

    • C. 

      Mannitol is contraindicated as a diuretic in this clinical situation

    • D. 

      Isoproterenol is a poor choice as an ionotropic agent

  • 87. 
     Which of the following statement(s) is/are true concerning the autoregulation necessary to maintain oxygen consumption and oxygen delivery?
    • A. 

      A change in oxygen consumption is followed by a proportionate change in oxygen delivery

    • B. 

      A change in oxygen delivery is followed by a change in oxygen consumption

    • C. 

      Increases in oxygen delivery are due solely to an increase in cardiac output

    • D. 

      The normal ratio of oxygen delivery to consumption is 2:1

  • 88. 
     Phases of multiorgan failure will include:  Which of the following statement(s) is/are true concerning the assessment of protein reserve?
    • A. 

      Conventional serum proteins such as albumin and globulin are early indicators of malnutrition

    • B. 

      The total lymphocyte count reflects immune status and not nutrition

    • C. 

      Antigen skin testing reflects patient immunity and not nutrition

    • D. 

      Measurement of urea excretion in urine can be used as a measurement of protein breakdown

  • 89. 
      Which of the following statement(s) is/are correct concerning the management of an open wound?
    • A. 

      Frequent surgical debridement is usually necessary

    • B. 

      Water irrigation can effectively debride most wounds

    • C. 

      Hydrogen peroxide is particularly useful in the management of open wounds

    • D. 

      A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing

  • 90. 
    Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
    • A. 

      Age over 70 years.

    • B. 

      Chronic malnutrition.

    • C. 

      Controlled diabetes mellitus.

    • D. 

      Long-term steroid use.

    • E. 

      Infection at a remote body site.

  • 91. 
    Which of the following statements about extracellular fluid are true?
    • A. 

      The total extracellular fluid volume represents 40% of the body weight.

    • B. 

      The plasma volume constitutes one fourth of the total extracellular fluid volume

    • C. 

      Potassium is the principal cation in extracellular fluid.

    • D. 

      The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid

    • E. 

      The interstitial fluid equilibrates slowly with the other body compartments.

  • 92. 
    In the nutritional support of patients with cancer, which of the following statements is/are true?
    • A. 

      Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow

    • B. 

      In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied.

    • C. 

      Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition

    • D. 

      Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

  • 93. 
    1.       Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
    • A. 

      The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.

    • B. 

      With normal renal function, this patient is likely to be volume overloaded.

    • C. 

      Proper fluid therapy would be unlikely to include potassium administration

    • D. 

      Insulin administration will increase the potassium content of cells.

    • E. 

      Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

  • 94. 
     Shock can best be defined as:
    • A. 

      Hypotension

    • B. 

      Hypoperfusion of tissues.

    • C. 

      Hypoxemia

    • D. 

      All of the above.

  • 95. 
    Which of the following statements regarding cytokines is incorrect?
    • A. 

      Cytokines act directly on target cells and may potentiate the actions of one another.

    • B. 

      Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.

    • C. 

      Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.

    • D. 

      Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates

  • 96. 
    All of the following are true about neurogenic shock except:
    • A. 

      There is a decrease in systemic vascular resistance and an increase in venous capacitance.

    • B. 

      Tachycardia or bradycardia may be observed, along with hypotension.

    • C. 

      The use of an alpha agonist such as phenylephrine is the mainstay of treatment

    • D. 

      Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

  • 97. 
    Which of the following statements about head injury and concomitant hyponatremia are true?
    • A. 

      There are no primary alterations in cardiovascular signs

    • B. 

      Signs of increased intracranial pressure may be masked by the hyponatremia.

    • C. 

      Oliguric renal failure is an unlikely complication

    • D. 

      Rapid correction of the hyponatremia may prevent central pontine injury

    • E. 

      This patient is best treated by restriction of water intake.

  • 98. 
    Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
    • A. 

      Age over 70 years.

    • B. 

      Chronic malnutrition.

    • C. 

      Controlled diabetes mellitus.

    • D. 

      Long-term steroid use.

    • E. 

      Infection at a remote body site.

  • 99. 
    Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true?
    • A. 

      Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications

    • B. 

      A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding

    • C. 

      Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy

    • D. 

      A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal

  • 100. 
    All of the following are true about neurogenic shock except:
    • A. 

      There is a decrease in systemic vascular resistance and an increase in venous capacitance.

    • B. 

      Tachycardia or bradycardia may be observed, along with hypotension.

    • C. 

      The use of an alpha agonist such as phenylephrine is the mainstay of treatment

    • D. 

      Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.